Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment: Risk factors analysis

Giovanni Luca Ceresoli, Michele Reni, Giuseppe Chiesa, Angelo Carretta, Stefano Schipani, Paolo Passoni, Angelo Bolognesi, Piero Zannini, Eugenio Villa

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Abstract

BACKGROUND. Brain metastases (BM) are frequent sites of initial failure in patients with locally advanced nonsmall cell lung cancer (LAD-NSCLC) undergoing multimodality treatments (MMT). New treatment and follow-up strategies are needed to reduce the risk of BM and to diagnose them early enough for effective treatment. METHODS. The incidence rate of BM as the first site of recurrence in 112 patients with LAD-NSCLC treated with the same MMT protocol was calculated. The influence of patient, disease, and treatment- related factors on the incidence of BM and on the time-to-brain recurrence (TBR) was analyzed. RESULTS. BM as the first site of failure was observed in 25 cases (22% of the study population and 29% of all recurrences). In 18 of those cases, the brain was the exclusive site of recurrence. Median TBR was 9 months. The 2-year actuarial incidence of BM was 29%. Central nervous system (CNS) recurrence was more common in patients younger than 60 years (P = 0.006) and in whom bulky (> 2 cm) mediastinal lymph nodes were present (P = 0.02). TBR was influenced by age (P = 0.004) and by bulky lymph node disease (P = 0.003). Multivariate analysis confirmed the prognostic role of age, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. CONCLUSIONS. Our study confirmed a high rate of BM in patients with LAD-NSCLC submitted to MMT. Most of these CNS recurrences were isolated and occurred within 2 years of initial diagnosis. Age younger than 60 years was associated with an increased risk of BM and reduced TBR, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. Although our data require further validation in future studies, our results suggest that additional trials on prophylactic cranial irradiation and on intensive radiologic follow-up should focus on these high-risk populations.

Original languageEnglish
Pages (from-to)605-612
Number of pages8
JournalCancer
Volume95
Issue number3
DOIs
Publication statusPublished - Aug 1 2002

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Statistical Factor Analysis
Neoplasm Metastasis
Carcinoma
Lung
Brain
Recurrence
Therapeutics
Lymph Nodes
Non-Small Cell Lung Carcinoma
Incidence
Central Nervous System
Cranial Irradiation
Clinical Protocols
Population
Multivariate Analysis

Keywords

  • Brain metastases
  • Locally advanced
  • Multimodality treatment
  • Nonsmall cell lung cancer

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Ceresoli, G. L., Reni, M., Chiesa, G., Carretta, A., Schipani, S., Passoni, P., ... Villa, E. (2002). Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment: Risk factors analysis. Cancer, 95(3), 605-612. https://doi.org/10.1002/cncr.10687

Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment : Risk factors analysis. / Ceresoli, Giovanni Luca; Reni, Michele; Chiesa, Giuseppe; Carretta, Angelo; Schipani, Stefano; Passoni, Paolo; Bolognesi, Angelo; Zannini, Piero; Villa, Eugenio.

In: Cancer, Vol. 95, No. 3, 01.08.2002, p. 605-612.

Research output: Contribution to journalArticle

Ceresoli, GL, Reni, M, Chiesa, G, Carretta, A, Schipani, S, Passoni, P, Bolognesi, A, Zannini, P & Villa, E 2002, 'Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment: Risk factors analysis', Cancer, vol. 95, no. 3, pp. 605-612. https://doi.org/10.1002/cncr.10687
Ceresoli, Giovanni Luca ; Reni, Michele ; Chiesa, Giuseppe ; Carretta, Angelo ; Schipani, Stefano ; Passoni, Paolo ; Bolognesi, Angelo ; Zannini, Piero ; Villa, Eugenio. / Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment : Risk factors analysis. In: Cancer. 2002 ; Vol. 95, No. 3. pp. 605-612.
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abstract = "BACKGROUND. Brain metastases (BM) are frequent sites of initial failure in patients with locally advanced nonsmall cell lung cancer (LAD-NSCLC) undergoing multimodality treatments (MMT). New treatment and follow-up strategies are needed to reduce the risk of BM and to diagnose them early enough for effective treatment. METHODS. The incidence rate of BM as the first site of recurrence in 112 patients with LAD-NSCLC treated with the same MMT protocol was calculated. The influence of patient, disease, and treatment- related factors on the incidence of BM and on the time-to-brain recurrence (TBR) was analyzed. RESULTS. BM as the first site of failure was observed in 25 cases (22{\%} of the study population and 29{\%} of all recurrences). In 18 of those cases, the brain was the exclusive site of recurrence. Median TBR was 9 months. The 2-year actuarial incidence of BM was 29{\%}. Central nervous system (CNS) recurrence was more common in patients younger than 60 years (P = 0.006) and in whom bulky (> 2 cm) mediastinal lymph nodes were present (P = 0.02). TBR was influenced by age (P = 0.004) and by bulky lymph node disease (P = 0.003). Multivariate analysis confirmed the prognostic role of age, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. CONCLUSIONS. Our study confirmed a high rate of BM in patients with LAD-NSCLC submitted to MMT. Most of these CNS recurrences were isolated and occurred within 2 years of initial diagnosis. Age younger than 60 years was associated with an increased risk of BM and reduced TBR, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. Although our data require further validation in future studies, our results suggest that additional trials on prophylactic cranial irradiation and on intensive radiologic follow-up should focus on these high-risk populations.",
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T1 - Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment

T2 - Risk factors analysis

AU - Ceresoli, Giovanni Luca

AU - Reni, Michele

AU - Chiesa, Giuseppe

AU - Carretta, Angelo

AU - Schipani, Stefano

AU - Passoni, Paolo

AU - Bolognesi, Angelo

AU - Zannini, Piero

AU - Villa, Eugenio

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N2 - BACKGROUND. Brain metastases (BM) are frequent sites of initial failure in patients with locally advanced nonsmall cell lung cancer (LAD-NSCLC) undergoing multimodality treatments (MMT). New treatment and follow-up strategies are needed to reduce the risk of BM and to diagnose them early enough for effective treatment. METHODS. The incidence rate of BM as the first site of recurrence in 112 patients with LAD-NSCLC treated with the same MMT protocol was calculated. The influence of patient, disease, and treatment- related factors on the incidence of BM and on the time-to-brain recurrence (TBR) was analyzed. RESULTS. BM as the first site of failure was observed in 25 cases (22% of the study population and 29% of all recurrences). In 18 of those cases, the brain was the exclusive site of recurrence. Median TBR was 9 months. The 2-year actuarial incidence of BM was 29%. Central nervous system (CNS) recurrence was more common in patients younger than 60 years (P = 0.006) and in whom bulky (> 2 cm) mediastinal lymph nodes were present (P = 0.02). TBR was influenced by age (P = 0.004) and by bulky lymph node disease (P = 0.003). Multivariate analysis confirmed the prognostic role of age, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. CONCLUSIONS. Our study confirmed a high rate of BM in patients with LAD-NSCLC submitted to MMT. Most of these CNS recurrences were isolated and occurred within 2 years of initial diagnosis. Age younger than 60 years was associated with an increased risk of BM and reduced TBR, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. Although our data require further validation in future studies, our results suggest that additional trials on prophylactic cranial irradiation and on intensive radiologic follow-up should focus on these high-risk populations.

AB - BACKGROUND. Brain metastases (BM) are frequent sites of initial failure in patients with locally advanced nonsmall cell lung cancer (LAD-NSCLC) undergoing multimodality treatments (MMT). New treatment and follow-up strategies are needed to reduce the risk of BM and to diagnose them early enough for effective treatment. METHODS. The incidence rate of BM as the first site of recurrence in 112 patients with LAD-NSCLC treated with the same MMT protocol was calculated. The influence of patient, disease, and treatment- related factors on the incidence of BM and on the time-to-brain recurrence (TBR) was analyzed. RESULTS. BM as the first site of failure was observed in 25 cases (22% of the study population and 29% of all recurrences). In 18 of those cases, the brain was the exclusive site of recurrence. Median TBR was 9 months. The 2-year actuarial incidence of BM was 29%. Central nervous system (CNS) recurrence was more common in patients younger than 60 years (P = 0.006) and in whom bulky (> 2 cm) mediastinal lymph nodes were present (P = 0.02). TBR was influenced by age (P = 0.004) and by bulky lymph node disease (P = 0.003). Multivariate analysis confirmed the prognostic role of age, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. CONCLUSIONS. Our study confirmed a high rate of BM in patients with LAD-NSCLC submitted to MMT. Most of these CNS recurrences were isolated and occurred within 2 years of initial diagnosis. Age younger than 60 years was associated with an increased risk of BM and reduced TBR, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. Although our data require further validation in future studies, our results suggest that additional trials on prophylactic cranial irradiation and on intensive radiologic follow-up should focus on these high-risk populations.

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KW - Locally advanced

KW - Multimodality treatment

KW - Nonsmall cell lung cancer

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